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� � Sec.13.04 RIGIiTS OF SUBJECTS OF DATA • • Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Informadon req�red to be given individual. An individual asked to supply private or confidenaal dara concerning himself shall be informed of: (a)the purpose and inrended use of the requated data wi[hin the collecdng State agency,potiacal subdivision,or statewide sysum; (b)whether he may refuse oY is legaily required to supply the mquesud data;(c)any Imown consequence arising from his supplying or refusing to supply priva[e or confidenaal data;and(d)[he idenriry of other persoas or enuties aurhorized by state or federel law to receive the dara. This requirement shall not apply when an individual is asked to supply invesrigadve dare,punuant[o secdon 13.82,subdivision 5, to a law enforcemen[o�cer. The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or proaertv taz refund insnvcdons instead of on those forms. Subd. 3. Access to data by individual. Upon requcst to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to him and,-if he desires,shall be informed of the content and meaning of rhat data. After an individual has been shown che priva[e data and informed of its meaning,the data need not be disclosed to him for siz months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsibie authoriry sha(1 provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry may requiro the roquesdng person to pay the actual cosa of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,wi[h any request made pursuant to this subdivision,or within five days of the date of the request,ezcluding Samrdays,Sundays and legal holidays,if immediau compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. M individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing[he nantre of the disagmement. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccursie or incomplete and attempt to nodfy pasc recipienu of inaccurate or incomplete data, inciuding recipients named by the individual;or(b)nodfy the individual thac he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The decerminadon of the responsible authority may be appealed pursuanc to the provisions of the adminisaative procedure act relaang to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request for a pemut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified thar. 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3, The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6, Your full name is re uired to process this application or permit. � Middle Last F«s� �Lv✓� s� � s Ly w-�-.�-� -- Address rn� s S 3� � y �� -� � 1'VI o ri� Ciry Sm� Zip Phone I understand my rights as s d above. Signature